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Health workers fill gaps for millions of Zimbabwean villagers

The health sector in Zimbabwe is a mix of public and private institutions; the latter are expensive, charge more, and provide better services compared to government-run institutions. In Shurugwi, there is three private facilities, but most local residents cannot afford these services due to poverty and opt for public clinics. Others rely entirely on the services of health workers who make community rounds. Shurugwi consists of 13 districtswith a population of 23,350 according to a 2014 census.

The pandemic has further stretched the system. “Over the past few months, Covid-19 has increasingly become a mainstream issue, killing large numbers of community members,” Chinenyanga said in January following a spike in Covid-19 cases in the country. The deaths came with shortages of almost all basic necessities: quarantine facilities, personal protective equipment, medicines and doctors. Like many places around the world, the country has also struggled with people sharing fake news about the dangers of vaccination.

Applying Covid-19 protocols can be exhausting for Chinenyanga. Every day, she must convince rural villagers, mostly small-scale gold miners in the region, many of whom are skeptical of vaccines, to mask up, practice physical distancing, disinfect and avoid gatherings in places like pubs, where people tend to forgo prevention measures.

Despite some pockets of vaccine hesitancy, as of June 7, 2022, a total of 4.3 million Zimbabweans have been fully vaccinated against Covid-19, or about 28% of the population. More than a million received a booster shot.

“In Shurugwi, people got scared when their family members started dying from Covid-19,” Chinenyanga says. “A family would lose both wife and husband. That’s when locals began to realize that Covid-19 was not just a flu, but a deadly disease that had spread through our community.

Owhen Zimbabwe won independence from the United Kingdom in 1980, the health sector in the new country embraced a strong and focused health care system, moving from providing more advanced health care services to the urban population to involving of the most vulnerable sections of society in rural areas. Health workers like Chinenyanga now play a central role in the country’s health systems, says Samukele Hadebe, senior fellow at the Chris Hani Institute, a South African think tank.

In rural areas, health workers need to be provided with both finances and resources to do their job effectively, he adds, because the majority of people depend on them.

“If you come from a health background, you’ll realize that the people who succeeded in building universal health care or a viable health system weren’t medical specialists,” he says. “Wherever there is a functioning health care system, it is really basic community health care, which in some countries does not even receive salaries. These are the people who fight for recognition. These are the people who manage the fundamental work.

But over the years, says Hadebe, Zimbabwe’s government has neglected the rural health sector by failing to take care of its health workers and paying them inadequate salaries, causing many skilled workers to leave. the country for better opportunities abroad. In Zimbabwe, the infrastructure has disappeared, he adds, and health workers “from basic to specialist are leaving the country. Why? Not just because of salaries, but because someone is going to leave the country because they are worried about social security.

Zimbabwe 2010 Health system assessment from USAID, a US federal agency focused on overseas development, shows that there has been a dramatic deterioration in Zimbabwe’s key health indicators from the early 1990s. Zimbabwe in 2022 is just under 62, an increase of 0.43% from 2021, according to United Nations projections.

With little hospital funding from the government, village health workers have to do their job with limited resources. Clinics like the one at Chinenyanga in Makusha are under-resourced and cannot accommodate patients with severe Covid-19 or other critical conditions, as there are no medicines or proper oxygen tanks.

Even the biggest hospitals in Zimbabwe do not always provide oxygen to every patient, especially if the patient cannot pay. “You must have money in advance,” Hadebe says. “And how many people can access it? So it’s a dire situation.

Itai Rusike, who leads the community health task force in Zimbabwe, agrees that most rural health facilities in the country were not equipped to deal with severe cases of Covid-19. In addition to the lack of oxygen tanks, he says, “we also don’t have intensive care units in our rural health facilities.” Most rural facilities do not have doctors, he adds, and nurses working in rural areas may also not be well equipped and skilled enough to treat severe cases of Covid-19.

In November 2021, the Minister of Finance and Economic Development, Mthuli Ncube, announcement that the country had acquired 20 million doses of vaccines. China reportedly pledged in mid-January to donate 10 million doses during 2022, which can be used for both initial and booster injections.

Rusike says to speed up the vaccination campaign program, community sensitization is needed, especially in rural areas. “We need to get people vaccinated,” he says, “rather than waiting for people to come to the health facility and get vaccinated.”

“I think it’s important, especially in remote areas, to come up with innovative strategies to get people vaccinated,” he adds. “We know there are some hard-to-reach areas where we can even use motorbikes to make sure people can get vaccinated where they are, in their communities.”

Ino more than shortage of resources, Chinenyanga has encountered another serious challenge most of the time in its work: misinformation and misinformation about vaccines.

The problem is common in rural areas of Zimbabwe, according to UNICEF communications officer Rutendo Kambarami, who says the most common reason communities do not take the vaccine is fear.

Even though a large portion of Zimbabwe’s population lives in rural areas, they are still connected on social media through mobile devices – and mobile devices and social media platforms allow abundant access to inaccurate information and misinformation. outright vaccine conspiracies. “So we realized we needed to give more information in order to dispel misinformation,” she said at a December workshop on Covid and mental health for journalists in Zimbabwe.

“Village health workers, as frontline workers, and even teachers were saying, we need to do more interpersonal communication in these areas,” she added. “So frontline workers play an incredibly huge role in terms of misinformation and disinformation.”

As Chinenyanga ends her day, after visiting several homes, she agrees that social media has contributed to misinformation. The people she serves in the Makusha community often share with her unproven remedies to treat Covid-19. She lists some of the misinformation she has seen so far. “People believe in steam, it helps. They also believe that eating Zumbani,” a woody shrub that grows in the country, “also prevents Covid-19,” she says.

Still, she manages to smile as she leans against her bike. She says she loves her work and its usefulness to the community. “As village health workers, our role is to share the information taught to us by the Ministry of Health,” she says. “We prioritize prevention as the most effective tool against Covid-19.”

Lungelo Ndhlovu is a Bulawayo-based freelance journalist and contributor to the Thomson Reuters Foundation.

This reporting project was produced with support from the International Center for Journalists and the Hearst Foundations under the ICFJ-Hearst Foundations Global Health Crisis Reporting Grant.

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